Provider Demographics
NPI:1326446287
Name:TARANTO, KYLE (MSW-LP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:TARANTO
Suffix:
Gender:M
Credentials:MSW-LP
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:FENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2226
Mailing Address - Country:US
Mailing Address - Phone:315-472-3171
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2226
Practice Address - Country:US
Practice Address - Phone:315-472-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100580104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid